Provider Demographics
NPI:1184876385
Name:REHUREK, PAMELA S (ASCP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:REHUREK
Suffix:
Gender:F
Credentials:ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7777
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:MT
Mailing Address - Zip Code:59035-7777
Mailing Address - Country:US
Mailing Address - Phone:406-666-2595
Mailing Address - Fax:
Practice Address - Street 1:HWY 212
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121416291U00000X
MT1009291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory